Doctors Still Having Problems With Choose And Book, British Medical Association Research Shows

Doctors are still struggling with the computer system intended to allow patients to book hospital appointments on the spot, new BMA research suggests today (Tuesday 27 January, 2009).

The electronic ‘Choose and Book’ referral service is intended to give NHS patients in England a choice of place, date and time for their first outpatient appointment. Doctors’ views about the system are mixed. Some are very positive and would be unwilling to revert to paper-based referrals. Others find it completely unworkable.

The BMA decided to investigate the disparities in their experiences by interviewing doctors in Hammersmith and Fulham Primary Care Trust – one of many localities across the country where there are large variations in usage It carried out 16 interviews with GPs, consultants, managers, and administrative staff. It found that GPs liked to be able to give patients control of their appointment, and administrators liked being able to track the progress of referrals. “When the system is working well it is amazing. The referral letter and appointment are made while the patient is sitting there,” one GP said.

However, even the most enthusiastic GPs said they sometimes struggled with system reliability, reporting for example that it crashed or was slow, or that they were unable to find clinics on the system. Such unreliability was seen as a significant barrier to use of the system. One practice reported that it took as long as 30 minutes to re-boot their systems following a crash.

Most of the consultants interviewed said Choose and Book had had little impact on their working practices. The small number who were using it to review appointments were struggling, reporting that it was slow and that there was insufficient time to use it, particularly during a busy clinic.

Dr Chaand Nagpaul, a GP and member of the BMA’s Working Party on IT, says:

“When Choose and Book works, it helps patients with the referral process, and gives them an idea of the relative waiting times for different clinics. It can also help inform GPs which clinics are available, or most appropriate for their patient.

“When it goes wrong, it is extremely frustrating – to the extent that some doctors find it is not worth using. Trusts and PCTs must ensure that systems are fit for purpose. They cannot expect doctors to be enthusiastic about a system if it is unreliable or slow. For their part, doctors can help improve the systems by recording and reporting problems.”

The report’s recommendations include:

– Greater collaboration between primary and secondary care

– Clinicians should be integral to any decision to increase the use of Choose and Book

– Robust local communications, and an analysis of demand, to address local capacity issues

– Local discussions to define how clinics are included on the Directory of Services to suit local needs

– Managers should ensure there is appropriate support and resources for Choose and Book users

– There should be a named contact at the PCT and trust so users can seek help, within an agreed timescale when experiencing problems